title: Effects of spironolactone on cardiac sympathetic nerve activity and left ventricular remodelling after reperfusion therapy in patients with first ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  To evaluate the effects of spironolactone on cardiac sympathetic nerve activity (CSNA) and left ventricular (LV) remodelling in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  Single-centre, prospective, randomised evaluation study.
  
  
  METHODS
  Patients with a first STEMI and single-vessel disease undergoing primary coronary angioplasty.
  
  
  METHODS
  Sixty patients randomly assigned to two groups before angioplasty.
  
  
  METHODS
  Patients were randomly assigned to receive or not the spironolactone before primary coronary angioplasty.
  
  
  RESULTS
  The extent score (ES) was determined by use of (⁹⁹m)Tc-pyrophosphate scintigraphy to evaluate the area of initial myocardial damage 3-5 days after primary angioplasty. The LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LV ejection fraction were determined by echocardiography, and plasma procollagen type III aminoterminal peptide (PIIINP) was measured before and 3 weeks after treatments. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from ¹²³I-meta-iodobenzylguanidine scintigraphy after 3 weeks.
  
  
  RESULTS
  After primary angioplasty, age, gender, risk factors, culprit coronary artery, peak serum creatine kinase concentration, recanalisation time and ES were similar in the two groups. However, in the spironolactone group, the TDS and WR were significantly lower (TDS: mean (SD) 22.5 (8.0) vs 29.5 (10.1), p<0.005, WR: 30.5 (8.7)% vs 40.0 (10.9)%, p<0.001) and the H/M ratio was significantly higher (2.18 (0.37) vs 1.96 (0.30), p<0.05) than in the non-spironolactone group. Moreover, significant correlations were found between the degree of change in PIIINP concentration and change in LVEDV (r=0.559, p=0.001), or LVESV (r=0.546, p=0.002) in the spironolactone group.
  
  
  CONCLUSIONS
  Administration of spironolactone improves CSNA and prevents LV remodelling in patients with a first STEMI.
authors.affiliation: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, Maebashi, Gunma 371-0034, Japan. s-kasama@bay.wind.ne.jp
authors.forename: Shu
authors.initials: S
authors.lastname: Kasama
authors.forename: Takuji
authors.initials: T
authors.lastname: Toyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sumino
authors.forename: Hisao
authors.initials: H
authors.lastname: Kumakura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takayama
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Minami
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ichikawa
authors.forename: Naoya
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kurabayashi
mesh_terms: D000368:Aged; D017130:Angioplasty; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D024061:Collagen Type III / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000294:innervation; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D013148:Spironolactone / Q000627:therapeutic use*; D015899:Tomography, Emission-Computed, Single-Photon; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D024061:Collagen Type III; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone